RESUMEN
The treatment of idiopathic scoliosis is challenging because of its diverse etiology, age of onset, and long duration of intensive treatment. We examined the effect of lateral electrical surface stimulation (LESS) in an animal model of experimental scoliosis (ES) assessing the number of motor end-plates (MEPs) as a study end-point. The control group (n=5) was adapted to the experimental apparatus without stimulation, whereas ES was induced in rabbits by one-sided LESS of the longissimus dorsi muscle (LDM) for a duration of 2 months. The ES group (n=5) were subjected to a short-term corrective electrostimulation applied at the contralateral side of the spine compared to the previous LESS stimulation for 2 h daily for 3 (n=5) or 6 months (n=5). Another group of ES rabbits was subjected to a long-term corrective electrostimulation applied for 9 h daily for 3 (n=5) or 6 months (n=5). LESS applied for 2 months (ES), significantly increased the number of MEPs in LDM. The short-term corrective electrostimulation for 3 months resulted in an increased number of MEPs. However, a decrease was observed in the animals treated for 6 months. The long-term corrective electrostimulation for 3 months did not change the density of MEPs in the LDM, but for 6 months the number of MEPs in the LMD significantly decreased by ES and control groups. Thus, the results of the present study clearly show that the short-term LESS is able to influence both the number of MEPs and the effectiveness of muscle correctional adaptation in a more efficient and harmless manner than the long-term procedure.
Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Estimulación Eléctrica/métodos , Placa Motora/fisiopatología , Escoliosis/fisiopatología , Escoliosis/terapia , Animales , Modelos Animales de Enfermedad , Femenino , Placa Motora/diagnóstico por imagen , Músculo Esquelético/diagnóstico por imagen , Músculo Esquelético/fisiopatología , Conejos , Radiografía , Escoliosis/diagnóstico por imagen , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/fisiopatologíaRESUMEN
Four cases of primitive neuroectodermal tumors (PNETs) with unusual localization (three intraspinal extramedullary and one pontocerebellar) are reviewed. Histologically, they were small round blue cell tumors with diverse patterns. Immunohistochemically, all tumors were positive for at least two neuronal markers, two cases were Mic-2 positive and one showed glial differentiation. The paraffin-embedded tumor specimens were examined by interphase FISH using dual-color probes specific for EWS, HER-2 and BCR loci. Molecular cytogenetic study revealed the presence of EWS rearrangement in two cases and the presence of i(17q) in one tumor. Three tumors exhibited 22 disomy and one was 22 polyploid. Extraparenchymal PNETs within craniospinal axis are heterogeneous from the clinical, histological, immunohistochemical and molecular point of view. These PNETs can be of a central or peripheral type. Multidisciplinary approach is of a basic importance in differential diagnosis of such cases.
Asunto(s)
Neoplasias del Sistema Nervioso Central/genética , Neoplasias del Sistema Nervioso Central/patología , Heterogeneidad Genética , Tumores Neuroectodérmicos Primitivos/genética , Tumores Neuroectodérmicos Primitivos/patología , Proteína EWS de Unión a ARN/genética , Adolescente , Adulto , Biomarcadores de Tumor/análisis , Biomarcadores de Tumor/biosíntesis , Neoplasias del Sistema Nervioso Central/química , Niño , Análisis Citogenético , Diagnóstico Diferencial , Resultado Fatal , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Hibridación Fluorescente in Situ/métodos , Masculino , Tumores Neuroectodérmicos Primitivos/química , PoliploidíaRESUMEN
An unusual posterior fossa neoplasm in a 26-year-old woman with short history of the cerebellar symptoms is presented. CT and MR images showed the tumor within the cerebellopontine angle, suspected as meningioma. At surgery, the tumor was dura-attached and did not infiltrate the arachnoid. Histologically, the neoplasm was a small blue cell tumor with solid and microcystic pattern, consistent with primitive neuroectodermal tumor (PNET). Immunohistochemically the cells were strongly positive for NCAM and GFAP. Fluorescence in situ hybridization (FISH) was performed with the cosmids G9 and F7 (flanking EWSR1/22q12 region) DNA probes and dual-color spectrum-orange LSI HER-2/neu (17q11.2)/spectrum green CEP17 (17p11.1-q11.1) DNA probe. The presence of isochromosome 17q within neoplastic cells was found. The tumor was classified as a medulloblastoma. We demonstrate the utility of a multidisciplinary approach to nervous system tumor diagnosis. The clinical features together with histological, immunohistochemical, and characteristic molecular alteration allowed classification of the presented case.
Asunto(s)
Neoplasias Cerebelosas/diagnóstico , Neoplasias Cerebelosas/genética , Ángulo Pontocerebeloso/patología , Cromosomas Humanos Par 17 , Isocromosomas/genética , Meduloblastoma/diagnóstico , Meduloblastoma/genética , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnósticoRESUMEN
Extraforaminal lumbar disc herniations with spinal nerve compression are a well-recognised entity. The diagnosis is difficult although the clinical syndrome is quite characteristic. Myelography fails to disclose these lesions, while CT, MRI or discography are helpful. The best approach to the extreme-lateral lumbar disc herniation is microsurgical decompression of the spinal nerve via the intertransverse muscle, ligament and fascia. With this approach, there is no facet destruction and satisfactory nerve root decompression is safe and effective in relieving radicular pain.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Adulto , Descompresión Quirúrgica , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Vértebras Lumbares/cirugía , Imagen por Resonancia Magnética , Microcirugia , Persona de Mediana Edad , Compresión de la Médula Espinal/diagnóstico , Compresión de la Médula Espinal/etiología , Tomografía Computarizada por Rayos XRESUMEN
Results of microsurgical discectomy (MSD) carried out in 151 patients with lumbar disc herniations are presented. The advantage of microsurgical discectomy is reduction of surgical trauma, better differentiation of anatomical structures, gentler manipulation around nerve roots and the dural sac, and the possibility of a meticulous hemostasis preventing profuse bleeding. Further advantages of MSD are: possibility of direct insight in intervertebral space, limited risk of peri- and postoperative complications and infection, reduction of nursing care, favourable psychological and cosmetic effects. Also possibility of improving microsurgical technique be performing these frequent in neurosurgical practice procedures is not insignificant. Final results were evaluated 6 months after MSD using the Functional Economic Rating Scale developed by Prolo et al. Very good outcome (score 8-10) was achieved in 129 patients (85.4%), good (score 6-7) in 18 (11.9%) and unsatisfactory only in 4 (2.7%).
Asunto(s)
Discectomía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Adulto , Humanos , Microcirugia/métodos , Estudios RetrospectivosRESUMEN
A case of 14-years-old girl with superficial temporal artery aneurysm is presented. She sustained head injury six weeks before the first symptom. Presence of the recent blunt trauma in confrontation with MRI lead to establishing of the final diagnosis. It must be considered in the differential diagnosis of masses located in the temporal fossa. Surgical resection of the involved segment of the vessel is indicated in the cases without the need of reconstruction. The result of treatment in our case was excellent and all symptoms have resolved. The aneurysmal character of the lesion was confirmed by histopathological examination.
Asunto(s)
Traumatismos Craneocerebrales/complicaciones , Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/patología , Arterias Temporales/patología , Adolescente , Diagnóstico Diferencial , Femenino , Humanos , Aneurisma Intracraneal/cirugía , Imagen por Resonancia Magnética , Arterias Temporales/cirugíaRESUMEN
A study of 73 patients who underwent reoperation for persistent or new complaints following initial lumbar discectomy is presented. 32 patients showed true recurrence of disc herniation (6 on the contralateral side) and 41 at a different level. 14 patients needed 3rd operation. Final results were evaluated using the Functional Economic Rating Scale elaborated by Prolo. Mean score for group operated on twice was 8.1 according to Prolo and 7.1 for group operated on 3 times.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Humanos , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares/cirugía , Reoperación , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
The finding of gas within the vertebral disc space ("vacuum phenomenon") is relatively common. Degenerative spine disease, gaseous degeneration of the intervertebral disc, and epidural gas were disclosed on imaging study. The epidural gas could be attributed to gaseous disc degeneration. The nerve root in presented patient was compressed by epidural gas. Following surgery the clinical syndrome including foot drop has thoroughly resolved.
Asunto(s)
Pie/fisiopatología , Gangrena Gaseosa/complicaciones , Gangrena Gaseosa/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Paresia/etiología , Paresia/fisiopatología , Adulto , Espacio Epidural/cirugía , Femenino , Humanos , Vértebras Lumbares/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Meningiomas of the lateral ventricles of the brain are rare tumours, accounting for approximately 0.5-5% of all intracranial meningiomas. Their natural history and symptomatology and the possibilities of early diagnosis are presented. The intraventricular location of the slow-growing benign mass provides a compensatory mechanism in the form of reserve space, which contributes to the delay in clinical demonstration of symptoms and signs. This makes the choice of diagnostic procedure an essential problem. CT and MRI are useful in detecting these masses, and magnetic resonance angiography (MRA) has also proved to be of great value in demonstrating the vascular supply of the tumour. This paper deals with two cases. In case 1 CT, MRI and MRA and in case 2 CT examination proved to be very useful. The tumours were removed by a transcortical approach in the posterior area.
Asunto(s)
Neoplasias del Ventrículo Cerebral/diagnóstico , Meningioma/diagnóstico , Adolescente , Neoplasias del Ventrículo Cerebral/patología , Neoplasias del Ventrículo Cerebral/cirugía , Ventrículos Cerebrales/patología , Niño , Femenino , Humanos , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Masculino , Meningioma/patología , Meningioma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A clinical analysis of 95 patients with posterior fossa tumors treated in the Department of Neurosurgery of the Medical University in Gdansk over a period of 16 years (1979-1995) is presented. The following preoperative factors were studied: localization, size and suspected type of tumor, size of the ventricular system, and presence or absence of the "halo" symptom. The indications for ventricular drainage (Fisher) versus V-P shunting as a preliminary treatment are discussed. Finally, the advantages of each of these procedures are emphasized.
Asunto(s)
Neoplasias Encefálicas/cirugía , Tronco Encefálico/cirugía , Neoplasias Cerebelosas/cirugía , Neoplasias del Ventrículo Cerebral/cirugía , Hipertensión Intracraneal/cirugía , Derivación Ventriculoperitoneal , Ventriculostomía , Astrocitoma/mortalidad , Astrocitoma/cirugía , Neoplasias Encefálicas/mortalidad , Neoplasias Cerebelosas/mortalidad , Neoplasias del Ventrículo Cerebral/mortalidad , Niño , Fosa Craneal Posterior , Ependimoma/mortalidad , Ependimoma/cirugía , Femenino , Humanos , Hipertensión Intracraneal/mortalidad , Masculino , Meduloblastoma/mortalidad , Meduloblastoma/cirugía , Complicaciones Posoperatorias/mortalidad , Tasa de SupervivenciaRESUMEN
The finding of gas within the vertebral disc space (vacuum phenomenon) is relatively common. This disorder often presents major diagnostic and therapeutic challenges, especially in the presence of multiple degenerative changes and chronic back pain in elderly patients. The author describes pathophysiology and diagnostics of gaseous degeneration associated with the herniated disc. Degenerative spine disease, gaseous degeneration of the intervertebral disc and epidural gas can be disclosed by imaging studies. The presence of epidural gas is attributed to gaseous disc degeneration. This pathology may cause radicular pain similar to sciatic pain produced by disc herniation. Surgery might be indicated in these cases.
Asunto(s)
Gases/análisis , Desplazamiento del Disco Intervertebral/diagnóstico , Vértebras Lumbares , Dolor de Espalda/etiología , Enfermedad Crónica , Humanos , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/cirugía , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos XRESUMEN
Meningiomas of the lateral ventricles of the brain are rare tumours with an approximate incidence of 0.5-4.5% among all intracranial meningiomas. Four cases of intraventricular meningioma arising from the trigone are presented. In 1-st case the calcified mass was visible on straight radiographs. In 2-nd and 3-rd cases CT and angiography was performed. In 4-th case MRI and MRA proved to be very useful. The tumours were removed by transcortical approach in the posterior parietal area. The available literature on intraventricular meningiomas has been discussed.
Asunto(s)
Neoplasias Encefálicas/cirugía , Ventrículos Cerebrales , Neoplasias Meníngeas/cirugía , Meningioma/cirugía , Adulto , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiología , Angiografía Cerebral , Electroencefalografía , Resultado Fatal , Femenino , Humanos , Incidencia , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/epidemiología , Meningioma/diagnóstico , Meningioma/epidemiología , Tomografía Computarizada por Rayos XRESUMEN
Diagnostic difficulties in a patient with primary malignant lymphoma of the brain are presented. Computerized tomography scans disclosed, at the beginning, a large mass located in the frontocallosal region, and 15 months later another focus in the cerebellum. Differential diagnostic considerations based on CT and NMR pictures, included infectious diseases, demyelinating diseases also metastatic tumours. The patient was successfully treated surgically, and had than radiotherapy.
Asunto(s)
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patología , Encéfalo/patología , Linfoma/diagnóstico , Linfoma/patología , Encéfalo/cirugía , Neoplasias Encefálicas/cirugía , Terapia Combinada , Diagnóstico Diferencial , Humanos , Linfoma/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Radioterapia , Tomografía Computarizada por Rayos XRESUMEN
The authors report a case of injury of the anterior cranial fossa by foreign body penetrating through the orbit with rhinorrhoea and brain damage in a child. Early operation prevented primary and secondary complications.
Asunto(s)
Cuerpos Extraños/diagnóstico , Órbita/lesiones , Rinorrea de Líquido Cefalorraquídeo/etiología , Preescolar , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Humanos , Masculino , Órbita/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A case of 60 years old female with far-lateral disc herniation within lumbar spine is presented. The herniated disc has been excised from the lateral muscle splitting approach with the use of microscope.
Asunto(s)
Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Microcirugia/métodos , Femenino , Humanos , Microscopía/métodos , Persona de Mediana EdadRESUMEN
Three cases of intracranial epidermoids treated surgically are reported. Typical course, histological appearance, diagnostic value of radiological investigations and surgical procedure are presented. In differential diagnosis dermoids and cholesterol granulomas (cholesteatomas) are widely discussed.
Asunto(s)
Colesteatoma/diagnóstico , Quiste Epidérmico/diagnóstico , Adulto , Colesteatoma/patología , Colesteatoma/cirugía , Electroencefalografía , Quiste Epidérmico/patología , Quiste Epidérmico/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
An unusual case of a 14-year-old boy with spontaneous chronic spinal epidural haematoma treated surgically with full success is reported. The clinical presentation and aetiology are discussed. The result of treatment depends mainly on the time of duration of neurological deficit. Immediate transfer to neurosurgical department gives a chance of good recovery.
Asunto(s)
Hematoma Epidural Craneal/diagnóstico , Enfermedades de la Médula Espinal/diagnóstico , Adolescente , Enfermedad Crónica , Hematoma Epidural Craneal/diagnóstico por imagen , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Mielografía , Enfermedades de la Médula Espinal/diagnóstico por imagen , Enfermedades de la Médula Espinal/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A method is described in which the volumes of intracerebral haematomas were retrospectively measured by a method of best-fitting circles, in 173 consecutive patients. 173 patients were operated on and 41 were treated conservatively. Prognosis in supratentorial haematomas of the volume up to 65 ml is better by 20% when they are treated conservatively. It seems that surgical treatment should be reserved for patients with haematomas over 65 ml presenting progressive deterioration of neurological condition. On the other hand, patients with infratentorial haematoma over 14 ml of volume should be operated on as quickly as possible.
Asunto(s)
Enfermedades Cerebelosas/terapia , Cerebelo/diagnóstico por imagen , Hemorragia Cerebral/terapia , Hematoma/terapia , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Enfermedades Cerebelosas/diagnóstico por imagen , Enfermedades Cerebelosas/patología , Cerebelo/patología , Hemorragia Cerebral/diagnóstico por imagen , Hemorragia Cerebral/patología , Niño , Femenino , Hematoma/diagnóstico por imagen , Hematoma/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
A case of pinealoma is described in a patient aged 16 years who had been treated initially conservatively with ventriculoperitoneal shunting and cobalt irradiation of the whole brain. The spine was not irradiated because of absence of histological examination. After 6 months the patient returned to hospital with paraparesis and pains in the sacral area. Myelography demonstrated contrast stop at the Th10-11 level. The surgically removed tumour was a pinealoblastoma. Improvement was achieved after postoperative treatment with methotrexate, vincristine and belustin.